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Lymph node removal (lymphadenectomy)


Expert reviewer, Mr Robert Hardy, Consultant Surgeon
Next review due November 2020

Lymph node removal is a surgical procedure to take out one or more of your lymph nodes. Your doctor may recommend this procedure if you’ve been diagnosed with cancer.

There are two main reasons for removing lymph nodes. One or more lymph nodes may be removed to check whether your cancer has spread. Knowing this helps your doctor plan the best cancer treatment for you. And if tests have shown that the cancer has reached your lymph nodes, you may have them taken out to remove the cancer. This helps to reduce the chance that your cancer will come back.

We can only give a very general overview of removal of lymph nodes here. Your experience may vary depending on the type of cancer you have and your own individual circumstances.

An image showing a diagram of the lymphatic system

What are lymph nodes?

Lymph nodes are small, kidney bean-shaped organs found throughout your body, particularly in your armpits, neck and groin. They are part of the lymphatic system. This is a network of thin tubes that carries a clear fluid called lymph from around your cells back to your bloodstream. Your lymph nodes help to fight infection and filter lymph fluid. They trap any bacteria and waste products in lymph and destroy old or abnormal cells, such as cancer cells.

Many types of cancer spread through the lymphatic system. The nearby lymph nodes are one of the first places they spread to. So taking out a lymph node to check for cancer cells can be a good way to show whether your cancer has spread. See our FAQ below to find out which cancers are most likely to spread to your lymph nodes.

Medical terms used in lymph node removal

You may hear a number of different medical terms used when describing lymph node removal. Some of the most usual ones are listed here.

  • Lymphadenectomy – this is the medical term for lymph node removal.
  • Lymph node (excision) biopsy – just one node is removed to check for cancer cells.
  • Sentinel lymph node – this is the first lymph node your cancer is likely to spread to. If this lymph node is removed the procedure is called sentinel lymph node biopsy. See our FAQ below for more information about this procedure.
  • Lymph node dissection (or clearance) – many lymph nodes are taken out together. An example is axillary lymph node dissection for breast cancer where your surgeon removes many nodes from your armpit (axilla).

Preparing for lymph node removal

Your hospital will give you information about your procedure, including how to prepare for it. You’ll probably be invited to a pre-admission assessment clinic at the hospital a week or two before the date of your operation. There your nurse will check your general health and may do some tests, including blood tests.

If you smoke, you’ll be asked to make every effort to stop before your procedure. This is because smoking increases your risk of getting a chest and wound infection, which can slow down your recovery.

If you’re going to have a general anaesthetic, your hospital will give you clear instructions on when to stop eating and drinking. This is usually from around six hours before your procedure – but always follow the advice you’re given.

Your nurse or surgeon will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you’re happy to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

Your nurse will prepare you for your operation. You may be asked to wear compression stockings which help prevent blood clots forming in the veins in your legs.

What happens during lymph node removal?

The anaesthetic you have will depend on exactly what procedure you’re having. Although you can have a local anaesthetic for some procedures, if you’re having many lymph nodes removed you’ll probably have general anaesthesia. This means you’ll be asleep during the procedure.

The details of your operation will depend upon a number of things, including how many lymph nodes are being removed and where they are. Your surgeon will explain beforehand what the operation will involve.

If you’re having a sentinel lymph node biopsy, you may have a scan involving an injection of a radioactive substance before your operation. Your surgeon may also inject a blue dye into the cancer site during your operation. This helps them find the sentinel node so they can remove it. See our FAQ below for more information about a sentinel node biopsy.

In most cases, your surgeon will make a small cut in the affected area and identify the lymph nodes to be removed. They’ll then carefully remove these and close the cut with dissolvable stitches in most cases.

In some circumstances your surgeon may recommend keyhole surgery. Instead of one main cut they’ll make several small cuts. They’ll pass surgical instruments through these cuts and use images on a computer screen to see your lymph nodes and remove them.

After surgery, your lymph nodes will be sent to a laboratory to see if there are any cancer cells in them.

What to expect afterwards

If you had a procedure under local anaesthetic, you’ll need to take it easy until feeling returns to the area. Be careful not to bump the affected area during this time. Similarly if you had a general anaesthetic, you’ll need to rest while all the effects wear off. You might have some discomfort as this happens but you’ll be offered pain relief as you need it.

You may have fine tubes running out from your wound. These drain fluid into a bag and are usually removed after a few days. You’ll have a dressing covering your wound. Your nurse or surgeon will tell you when you can remove this.

If your surgeon has used dissolvable stitches, these won’t need to be removed but will dissolve completely when the area is healed.

If you had general anaesthesia, you’ll need to arrange for someone to drive you home. This is a good idea even if you had a local anaesthetic. Try to have a friend or relative stay with you for the first 24 hours after you get home.

Having a general anaesthetic affects everyone differently and in ways you may not expect. You might find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s advice.

You’ll be given advice about caring for your healing wounds before you go home, as well as a date for a follow-up appointment. You may find it helpful to read our topic on caring for surgical wounds.

It may take up to two weeks for the laboratory test results to come back. These say whether cancer cells were found in the lymph nodes. Results are usually sent to the doctor who requested your procedure. Your doctor will talk to you about your results at your follow-up appointment.

Recovering from lymph node removal

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine. If you have any questions, ask your pharmacist for advice.

How long it will take to get back to normal after your lymph node removal surgery will vary depending on your circumstances. Ask your surgeon when you’re likely to be able to resume your usual activities, including getting back to work. Check whether there are any restrictions on what you can do for a while – for instance strenuous exercise or heavy lifting. Always follow your surgeon’s advice.

For tips on reducing your risk of long-term problems after lymph node removal, see our section on lymphoedema below.

Side-effects

Like all procedures, lymph node removal can cause some side-effects but these are mostly temporary. After having your lymph nodes removed, you may have:

  • pain, swelling and bruising
  • stiffness and reduced movement

Complications

Complications are when problems occur during or after the operation. All medical procedures come with some risks, however small. Ask your surgeon how these might affect you.

The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot.

Specific complications of having your lymph nodes removed can include:

  • an infection in your wound, which may mean you need antibiotics
  • a build-up of fluid in the lymph node area (seroma). This usually goes within a few weeks but your surgeon may need to drain it with a needle
  • injury to nerves near the site of your operation. This may cause areas of numbness of your skin
  • a slow build-up of fluid causing swelling in the affected arm or leg over months or years – called lymphoedema. See our section below for more information about this important long-term complication of lymph node removal

Long-term effects of lymph node removal – lymphoedema

What is lymphoedema?

Lymphoedema is the swelling of a part of the body due to poor drainage of lymph fluid. It can affect any part of your body but is most often seen in your arm or leg. If you have lymph nodes removed, there’s a risk that you may develop lymphoedema. You’re more likely to develop it if you have several lymph nodes removed and if you’ve had radiotherapy treatment for cancer.

What are the symptoms?

Symptoms of lymphoedema may include:

  • swelling in your arm or leg, which may be slight at first. You may notice your finger leaves a dent in your skin when you press it
  • a feeling of tightness, fullness and heaviness in your arm or leg
  • restricted movement in your affected arm or leg
  • skin changes, such as roughened or darkened skin
  • aching of your arm or leg

Symptoms often start at the far end of the limb – the hand or foot. And they may get gradually worse over time. Your symptoms may be worse in warm weather or, in women, just before a period.

If you’ve had lymph nodes removed and you develop any of these symptoms, tell your doctor or nurse. If you notice signs of an infection, such as redness, warmth, swelling or pain, contact your GP straight away.

What can I do to avoid lymphoedema?

You’ll continue to be at risk of developing lymphoedema for the rest of your life after having lymph nodes removed. But there are many things you can do to keep this risk as low as possible.

  • Look after your skin – keep it clean and moisturise at least once a day. Protect your skin from the sun and try to avoid getting cuts and grazes.
  • Keep active – exercise will make you feel better and may improve your lymphoedema. You can find out about specific exercises for lymphoedema from your physiotherapist. The organisations listed below also have information – see ‘other helpful websites’.
  • Raise the affected arm or leg on a cushion or pillow when you’re sitting or lying down.
  • Don’t wear tight clothes over the area where you had lymph nodes removed.
  • Keep to a healthy weight – being very overweight makes lymphoedema more likely to develop.
  • Discuss with your doctor whether it’s safe for you to have vaccinations, blood tests and intra-venous (IV) catheters in your affected arm or leg. You may also be advised not to have your blood pressure taken with a cuff around your arm.

If you develop lymphoedema, specialist nurses can advise you on how to prevent or treat it. This may include wearing special compression garments over the affected area, or having the area bandaged or massaged.

Having lymphoedema can be unpleasant, and can affect your quality of life. It’s understandable if it affects you emotionally or you find it hard to cope with. Ask for help if you need it – you’re not alone. Your GP or cancer nurse may be able to refer you to a lymphoedema specialist. And consider contacting one of the organisations we list below for further advice and support.

Frequently asked questions

  • If you have cancer, your doctor may recommend removing one or more of the lymph nodes closest to the site of your cancer. This is because cancer often spreads to other parts of your body through your lymphatic system. Your lymph nodes may be removed to find out if the cancer has spread or because it already has. Cancers for which this is most often done include melanoma, and cancers of the breast, colon, head and neck or penis.

  • A sentinel lymph node is the first lymph node your cancer is likely to spread to. Your surgeon may recommend taking out this node to see if it has any cancer cells in it. This procedure is called a sentinel lymph node biopsy. It helps your doctor decide on the best treatment for you. It’s most usually done if you have breast cancer or melanoma.

    Before they can remove the sentinel node, your surgeon has to find it. To help them do this, you may have a special scan in the nuclear medicine department of the hospital. This will be carried out by a radiographer (a health professional trained to perform imaging procedures). The scan may happen the day before, or the morning of your surgical procedure.

    Your radiographer will inject small amounts of a radioactive liquid into the area near your cancer. (The radioactivity you get is less than with a normal X-ray). About 15 minutes later, you’ll have a scan. This picks up the radioactivity and follows it on its path to the lymph nodes. The first lymph node that the radioactive liquid goes into is the sentinel node. Your radiographer may mark its position on your skin for your surgeon to see.

    During your surgery, your surgeon may also inject a special blue dye into the area of your cancer. This travels to the sentinel lymph node and dyes it blue. It makes it easier for the surgeon to find it.

    Once they locate the sentinel lymph node, your surgeon will surgically remove it and send it to the laboratory. If there are no cancer cells present, this may mean you don’t have to have any more lymph nodes removed.

  • No, having swollen lymph nodes doesn’t necessarily mean that you need to have them removed. That may be the case if you have cancer, but swollen nodes are usually caused by other things. However, it’s a good idea to see your GP if they stay enlarged for more than three or four weeks.

    Lymph nodes (or glands) are found throughout your body. Their main role is to fight infections and filter the lymph fluid that travels through them. Sometimes your lymph nodes may get bigger and you or your doctor may be able to feel them in your armpit, neck and groin.

    There are many reasons other than cancer why you might have enlarged lymph nodes. The most common cause is an infection, where the cells in the nearby lymph nodes work to filter out and fight the infection. For example, a throat infection might cause swollen nodes in your neck. Some medical conditions cause swollen nodes in many parts of your body at one time. This is still most likely to be due to an infection, for example glandular fever.

    Some of the causes of swollen lymph nodes will get better on their own, some will need treatment. If you notice that your nodes remain swollen for a few weeks, or you notice a new lump somewhere in your body, contact your GP.


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Related information

    • Lymphoedema. BMJ Best Practice. bestpractice.bmj.com, last updated 31 October 2016
    • Lymphatic system anatomy. Medscape. emedicine.medscape.com, updated 19 September 2013
    • Laparoscopic pelvic lymph node dissection. Medscape. emedicine.medscape.com, updated 28 October 2015
    • Axillary dissection. Medscape. emedicine.medscape.com, updated 14 November 2016
    • Sentinel lymph node biopsy in patients with melanoma. Medscape. emedicine.medscape.com, updated 6 September 2016
    • Generalised lymphadenopathy. PatientPlus. patient.info/patientplus, last checked 24 March 2014
    • Lymphedema. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2017
    • Lymphadenopathy. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2017
    • Surgical oncology. Oxford handbook of oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, published September 2015
    • Surgery to remove lymph nodes. Cancer Research UK. www.cancerresearchuk.org, last reviewed 25 October 2017
    • Sentinel lymph node biopsy. Cancer Research UK. www.cancerresearchuk.org, last reviewed 22 Jan 2016
    • Preparing for surgery. Cancer Research UK. www.cancerresearchuk.org, last reviewed 25 October 2017
    • Lymphoedema and cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 14 June 2017
    • Sentinel lymph node biopsy. DermNet New Zealand. www.dermnetz.org, updated July 2015
    • Lymph node surgery for breast cancer. American Cancer Society. www.cancer.org, last revised 13 September 2017
    • Sentinel lymph node biopsy. NIH National Cancer Institute. www.cancer.gov, reviewed 11 August 2011
    • Biopsy for lymphoma. Lymphoma Association. www.lymphomas.org.uk, last reviewed July 2016
    • Surgery for lymph node removal. Macmillan. www.macmillan.org.uk, reviewed 30 December 2016
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, November 2017
    Expert reviewer, Mr Robert Hardy, Consultant Surgeon
    Next review due November 2020



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